Eosinophilic esophagitis is associated with increased risk of allergic conjunctivitis: a multicenter cohort study

Eosinophilic esophagitis (EoE) is a chronic, Th2-driven inflammatory esophageal disease frequently associated with atopic disorders. However, ocular comorbidities in EoE, particularly allergic conjunctivitis, have not been well characterized. In this study, we compare the incidence of ocular outcomes, with a focus on allergic conjunctivitis, between patients with EoE and matched controls with gastroesophageal reflux disease with esophagitis (GERD-E).

We conducted a retrospective, propensity score-matched cohort study using the TriNetX Global Collaborative Network, including 23,488 patients with EoE and 23,488 matched GERD-E controls. Eligible patients had at least one ophthalmology encounter ≥ 30 days after the index diagnosis. The primary outcome was allergic conjunctivitis; secondary outcomes included dry eye syndrome, keratoconjunctivitis sicca, blepharitis, meibomian gland dysfunction, and uveitis. Kaplan-Meier analyses, log-rank tests, and Cox proportional hazards models were used to estimate hazard ratios (HRs) over a 3-year follow-up period.

EoE was associated with a higher 3-year risk of allergic conjunctivitis compared with GERD-E (HR 1.42; 95% CI [1.20,- 1.69]; p < 0.001). No significant differences were observed for dry eye syndrome, keratoconjunctivitis sicca, blepharitis, meibomian gland dysfunction, or uveitis. Positive and negative control outcomes supported internal validity.

Patients with EoE have an elevated risk of allergic conjunctivitis compared with GERD-E, consistent with the systemic Th2 inflammatory profile of EoE. Other ocular comorbidities were not significantly increased. These findings highlight the importance of multidisciplinary, allergy-aware care in patients with EoE.